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School-Based Asthma Therapy (SBAT) to Reduce Disparities in Childhood Asthma: Pragmatic Process and Program

学校哮喘治疗 (SBAT) 旨在减少儿童哮喘的差异：务实的流程和计划

基本信息

批准号：
10248567
负责人：
Kimberly Joan Arcoleo
金额：
$ 58.53万
依托单位：
UNIVERSITY OF RHODE ISLAND
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2023-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10248567
关键词：
17 year old Absenteeism Address Adherence Administrator Adopted Adoption Asthma Caregivers Caring Child Child Care Child health care Childhood Childhood Asthma Chronic Chronic Disease Cities Clinical Clinical effectiveness Data Disease Management Dissemination and Implementation Effectiveness Enrollment Ensure Evaluation Family Goals Guidelines Health Health Personnel Health system Healthcare Healthcare Systems Home Hospitals Human Resources Hybrids Instruction Insurance Carriers Intervention Medical Medical Research Medication Management Methods Modeling Morbidity - disease rate Nurses Ohio Outcome Pediatric Hospitals Pharmaceutical Preparations Physician-Hospital Organizations Pragmatic clinical trial Prevalence Preventive Process Program Evaluation Public Health Randomized Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Research Priority Resources Role School Nursing School-Age Population Schools Self Management Service delivery model Students Symptoms Testing Time Universities Work Youth asthma inhaler asthmatic base care coordination care outcomes chronic care model clinical effect contextual factors cost cost effective cost effectiveness design disparity reduction dissemination research dissemination strategy economic cost effectiveness implementation study effectiveness implementation trial effectiveness outcome efficacy study health care availability high risk implementation facilitation implementation framework implementation outcomes implementation process implementation research implementation strategy improved improved outcome innovation patient home care pragmatic trial program dissemination programs prototype satisfaction scale up school district screening success tool trial design usability user centered design

项目摘要

PROJECT ABSTRACT Over 25% of the nation’s school-aged children have one or more chronic health conditions and school nurses are responsible for coordinating care management with youth and their caregivers. Coordinated efforts improve health, reduce school absences, and mitigate the billions of dollars spent on youth disease management. However, pragmatic (“real world”) interventions to improve connection between nurses, youth, and their caregivers are nascent. One approach was developed by Dr. Halterman (co-I) and colleagues to ensure guideline-based treatment for children with persistent asthma through systematic school-based asthma screening and directly observed administration of asthma controller medications in school. This intervention was titled the School-Based Asthma Therapy (SBAT). Through numerous randomized controlled trials, SBAT was found to enhance asthma self-management and improve adherence to daily, effective preventive asthma care (clinical effect) as well as reduction in symptom-free days (cost-effective). SBAT is multidimensional, extending child asthma care from the home to the school setting. SBAT is high-impact because school-based programs can reach children at highest risk for asthma morbidity and optimize their care in the setting in which they spend most of their day, regardless of their contacts with the health care system. In alignment with the RE-AIM framework, the goal of this work is to improve the reach of students and effectiveness of asthma management outcomes, be broadly adopted among schools and school districts, be implemented with high quality and at a low cost, and be maintained within the schools and homes of asthmatic youth. Over the last five years, our team based at the Nationwide Children’s Hospital (NCH), its physician-hospital organization, Partners for Kids (PFK), and the University of Rochester has expanded the SBAT program beyond the original Columbus City and South Western City School Districts (Columbus, OH) and found strong adoption (17 to 225 schools) and reach (38 students to 559 students) outcomes with the application of SBAT. Despite the promises of SBAT, widespread dissemination of the program has not been fully achieved because a comprehensive assessment of real-world implementation and evaluation of this program has not been done. Our team is now poised to move from efficacy studies to a hybrid effectiveness-implementation study. We will conduct a rigorous, comprehensive evaluation of SBAT implementation outcomes (i.e., clinical and academic outcomes, and cost-effectiveness) when implemented in a real-world setting. We will also assess the implementation strategies in facilitating further dissemination and implementation of the SBAT program across a variety of schools. Dissemination and implementation research on this integrated, interprofessional, multidimensional SBAT program could serve as a model for programs that aim to improve asthma care and reduce morbidity for high risk children with asthma and has applications for other chronic health conditions.

项目摘要